Discharge and termination letters

Discharge and termination letters are formal notices that end care. Owners and admins manage the clinic-wide wording by clicking Settings in the left sidebar, then clicking Discharge Letters under Charting. A patient letter opens from the patient's chart and uses those settings as its starting point.

How do I set up discharge and termination letter defaults?

In the left sidebar, click Settings (at the bottom). In the settings menu, under Charting, click Discharge Letters to control the parts of the letter your clinic can edit. These settings apply to letters signed from now on; they do not change letters that are already signed.

The Settings (1) item opens the settings area, and Discharge Letters (2) is the charting settings page you use for this feature.

Use Wording (1) for the heading and clinic-specific language, Contents (2) for the medication section, and Reasons offered (3) for the reasons clinicians can pick.

1. In the left sidebar, click Settings (at the bottom). In the settings menu, under Charting, click Discharge Letters.
2. In Wording, enter Service name if the heading should name the type of care your practice provides.
3. Set Grace period. This controls how long emergency care and refills continue, and sets the default effective date on new letters.
4. Enter Records request phone if patients should call a specific number for records.
5. In Contents, turn Current prescriptions on if the letter should print active medications from the chart.
6. In Closing text, update Emergency support and Closing paragraph if your clinic needs custom language.
7. Select Save.

The page shows Discharge letters updated. Letters signed from now on use the saved settings.

How do I choose the reasons clinicians can select?

On the same page, click Discharge Letters under Charting to decide which reasons appear when someone writes a discharge or termination letter. If you select no reasons, the full list is offered.

Use Reasons offered (1) for the section header, and the first and second reason checkboxes (2, 3) for individual reasons clinicians can turn on or off.

1. On the same page, find Reasons offered.
2. Check each reason clinicians should be able to choose.
3. Select Offer all if you want to clear your selections and make the full list available again.
4. Select Save.

When a clinician writes a letter, only reasons that match the letter type appear. Switching between Termination and Discharge removes any selected reasons that do not apply to the new type.

How do I add continuity-of-care resources?

On the same page, click Discharge Letters under Charting to add organizations or websites that help patients find another provider. These resources print in the letter.

Use Continuity of care (1) for the section, Add resource (2) to add another resource row, Resource name (3) for the organization name, and Optional link (4) for the website address.

1. On the same page, select Add resource.
2. Enter the resource name.
3. Add a link if you want one printed with the resource.
4. Select Add resource again for additional entries.
5. Select Save.

If there are no resources, the letter asks patients to find a new provider without listing specific organizations.

How do I write a discharge or termination letter for a patient?

In the left sidebar, click Patients, then click the patient's name. In the patient chart footer, select Export, then select Discharge letter…. A draft starts when the sheet opens. If the patient already has an open draft, the sheet reuses it instead of creating another one. The sheet now shows an Issued letters section above the form when the chart already has final letters.

The Export (1) button opens the menu, and Discharge letter (2) starts the letter draft from the patient chart.

1. Under Letter, choose Termination when the practice is ending the relationship, or Discharge when care has concluded.
2. Set Date of letter and Effective date.
3. Under Reasons for termination or Reasons for discharge, select at least one reason. Use Search reasons to narrow the list, or select Other reason to type a free-text reason that prints on the letter.
4. Review Current prescriptions if that section is turned on. The list comes from the chart and is not edited in the letter.
5. In Printed details, review the patient's address and the provider's Provider, Credentials and NPI. Changes here apply to this letter only.
6. Add an Additional paragraph if this letter needs patient-specific wording.

The draft saves when you preview, sign, or generate the letter. Blank custom reasons are dropped when you save, and you cannot generate a letter until the dates are valid and at least one reason is selected.

How do I preview and sign a letter?

Use Preview before signing when you want to read the generated PDF at full page size. Signing stores the PDF on the patient's chart and freezes the letter.

1. On the same page, open the patient's chart, then select Export, then select Discharge letter….
2. Set valid Date of letter and Effective date.
3. In the discharge letter sheet, select Preview.
4. Review the PDF that opens in a new tab.
5. Return to the letter sheet and make any needed edits.
6. Select Generate and sign.
7. In Sign the discharge letter, draw your signature, or leave it blank to sign with the signature saved on your profile.
8. Select the signing button. It reads Sign with drawn signature after you draw, or Sign letter if you leave the pad blank.

The page shows Letter signed. The signed PDF is stored on the patient's chart, and the letter becomes read-only.

How do I issue a letter for hand signature?

Issue an unsigned letter when it needs to be printed and signed by hand. This is final in the same way as an electronically signed letter: the letter becomes read-only, and you must void it to replace it.

1. On the same page, open the patient's chart, then select Export, then select Discharge letter….
2. Set valid Date of letter and Effective date.
3. Complete the letter details and select at least one reason.
4. Select Generate unsigned.
5. In the confirmation dialog, select Generate unsigned again.

After you issue it, the page shows Unsigned and the banner says it was generated unsigned. Print it and sign by hand. The PDF is stored on the patient's chart.

How do I download or fax a final letter?

On the same page, open the patient's chart, then select Export, then select Discharge letter….

The Download PDF (1) item starts a download of the final PDF, and Discharge letter (2) is the menu item that opens the letter flow from the patient chart.

A letter can be shared only after it is signed or issued for hand signature. Drafts and voided letters cannot be downloaded or faxed from the share control.

1. Open the patient's chart, then open a signed or issued letter.
2. Use the final-letter download option to download the stored PDF.
3. If faxing is enabled for your organization, use the fax option on the final letter to prepare the PDF for faxing.

If the fax attachment cannot be sent, the page tells you before opening the fax dialog.

How do I correct a signed or issued letter?

Signed and issued letters are frozen. To correct one, void it and start a new letter.

1. On the same page, open the patient's chart, then select Export, then select Discharge letter….
2. Choose the option to void the letter.
3. Enter a reason if you want it recorded.
4. Confirm the void.
5. Start a new letter for the patient.

The page shows Letter voided. The signed copy stays on the chart as a record, and the replacement letter starts as a new draft.

What can't I do here?

Discharge and termination letters have these limits:

• Clinicians can write patient letters, but only owners and admins can manage discharge letter settings by clicking Settings in the left sidebar, then clicking Discharge Letters under Charting.
• You cannot generate a letter until at least one reason is selected and Date of letter and Effective date are valid.
• You cannot preview, sign, or issue a letter until Date of letter and Effective date are valid.
• You cannot edit a signed, issued or voided letter.
• You cannot share a draft letter. Finalize it first by signing it or issuing it for hand signature.
• You cannot share a voided letter from the share control.
• You cannot edit Current prescriptions in the letter. Update medications on the chart instead.
• Settings changes apply to letters signed from now on. They do not rewrite letters already signed.
• Blank custom reasons are dropped when you save the letter.

Common questions

What is the difference between Termination and Discharge?

Choose Termination when the practice is ending the relationship. Choose Discharge when care has concluded, such as goals met or care transferred. The available reasons change based on the type.

What does the grace period do?

Grace period controls how long emergency care and refills continue. It also sets the default Effective date on new letters. If the letter date and effective date are the same, the letter says care ends on the letter date. If the gap is shorter than the grace period, the date hint warns that it is under your grace period. Required notice varies by state.

Can an office manager sign for a provider?

The letter records the signer separately from the provider details printed on the letter. Owners, admins and clinicians can sign discharge letters.

What happens if the patient has no active medications?

If Current prescriptions is turned on and there are no active medications, the letter prints that there are no active prescriptions on record.

How do I update my NPI before sending letters?

You can edit the NPI in Printed details for one letter. To update your saved provider details, see Your NPI and individual insurance details.